For many of us (men included) Angelina Jolie has the best lips in the business. And from everything I gather, they are all natural! That brings me to the following anectdote...

I was sitting in the airport bar when a young lady came in and sat down next to me. I did not want to stare but, I did catch a glimpse (and a few more just to make sure that I was actually seeing what I thought I was!) This young lady had had her lips done and it was painfully obvious. I am not sure what look she was trying to accomplish but based upon the comments of the bar staff after she left, I am not sure she acheived her goal. Needless to say they ranged from x rated comments, to occasional envy, but most comments simply discussed how fake they looked.

It reminded me of a question that a dermatologist in St Pete asked me. She said that some of her patients wanted these really big lips, and she said that she felt like she was obligated to do it. She wanted to know how I dealt with these types of situations. I said to her that before I do any procedures with my patients, we have to agree on the expectations and the desired results, and if we do not, then I offer that patient someone else who may be more comfortable with what the patient wants. I am not sure what she decided, but I know that my patients and I are comfortable and hopefully very happy.

As a surgeon we have many different ways to change the lips, some permanent and some temporary, but for this blog I will focus on lip injections.

A word of caution. Natural is the way to go.

People who come into my office looking for larger lips fall into two categories. The younger group with fine lips, who have never been blessed with full lips, and the older group who have seen their once plump lips, fall from grace and now suffer with very thin lips. These two groups are quite different in their anatomy and should be dealt with differently. Come in and lets talk about this!

Occasionally additional augmentation is needed, remember you can always make them bigger but you can't make them smaller. The lips will swell after they are injected, so expect to be bigger for a while. We do a nice topical anesthetic, and then additional local anesthesia to make the experience far more enjoyable. Ice also helps.

Above is a young lady who had her lips injected by me a while back. Full lips, but not fake looking!

In terms of what fillers are to be used, I use Juvederm. It creates a wonderful soft natural lip. Other fillers can be used, but please do not put Radiesse in the lips, and stay away from silicone. These two fillers can have significant problems in the lips.

As you all know, rhinoplasty is a very large part of my practice, and I deal with countless people who come in to discuss rhinoplasty (nose job) surgery. One of the most frequently asked questions is at what age should a rhinoplasty be performed? Recently there was an article written by a plastic surgeon in California who stated that rhinoplasties can be done in 13- and 14-year-old children. (This was posted on our Facebook page). When polled, most rhinoplasty surgeons will have different answers; however, the range is from 13 to 18 years of age.

My opinion also falls within this age range. The youngest patients that I have operated on are 15. But I have told some 16-year-olds that they need to wait. This may sound contradictory, but it is not! So, what goes into this decision? For me the age is only one factor and, quite honestly, not the most important. The physical and emotional maturity of the patient needs to be considered. For this reason, I will almost never operate on a young patient without seeing this patient on more than one occasion. When I do this, I get to see how the patient is maturing on both fronts. I also like to see the relationship between Mom, Dad, and the patient. The physical stature of Mom and Dad is also important to know, as the patient will be similar at maturity. I could bore you with the growth areas of the nasal septum and the natural course of growth of the face in general, but I won’t. Suffice it to say, that the physical maturity is important. If a patient is fully mature physically, then I will consider the operation.

The patient’s emotional maturity, as well as the relationship with Mom and Dad, is also a significant consideration. “Why does the PATIENT want the surgery?” This needs to be worked out, and discussed. Often I will discuss this with the patient in the absence of both parents. It is really important to understand what is going on in the young person’s head (if this is possible). We need to remember that we are going to be changing the way this person looks, and is looked at. Will this person be ready for this? Are their expectations reasonable? Mom and Dad’s opinions are important, but not as important as the patient’s own thoughts about these matters. I ask all of my patients these things, but when dealing with younger patients, I take special care to discuss this. A few caveats about this: When a chin augmentation is needed as well, this often will need to wait for a bit more time. Also, when there is severe nasal obstruction (a severe functional deficit), this may push up the time table. So, now to finally answer the question: The magic number for me is around 15 (and I say this with great trepidation). Remember that just because you are 15, it does not mean that you are ready for this surgery. I reserve the right to tell you that we are not quite ready, and we will wait for a while. Also, all of you 13- and 14-year-olds out there who think you are ready, do not be surprised when I tell you that you are ready, and we can go ahead with the surgery. Hope this helps. Feel free to let me know.

I am hoping to have an entertaining and interactive forum where we all can discuss relevant topics about facial plastic surgery as well as many other interesting topics.As a board certified facial plastic surgeon, I do my best to stay involved and am very interested in the newest technologies and procedures.I will use this forum to discuss these.

But this Blog will not be only about facial plastic surgery.

There are so many related topics to the field of facial plastic surgery including skin care, anti-aging, food and wine (just checking that you were paying attention) and we will delve into these things as well.As many of you know, I am a huge fan of fine wines and foods, so do not be surprised if there are some great discussions of these.

I am hoping to open your eyes to many things that are interesting but may not be main stream.I look forward to hearing your ideas and suggestions for more topics of conversation.